For two doctors, there’s no need to debate any longer: Krokodil is in the United States, and it’s a real threat.

After at least a year of suspicion and debate over whether a flesh-eating drug krokodil had actually made it into the United States, two doctors may have brought the debate closer than ever to the conclusion that it has arrived.

Dany Thekkemuriyil and Unnikrishnan Pillai, both physicians at SSM St. Mary’s Health Center in Richmond Heights, Mo., reported treating a patient in their emergency room in December 2012. The 30-year-old man revealed thighs where skin was rotting away and a hand with a missing finger, telling the doctors that he had been injecting himself with the synthesized version of heroin made from a cocktail of codeine, gasoline and several other chemicals. He said he had been using the designer drug eight months before seeking treatment.

“We saw that his finger fell off and we saw a severe looking ulcer and sores on his thigh and it did really fit the picture of Krokodil,” Thekkemuriyil told KTVI-TV in St. Louis. He and Pillai submitted their findings to the American Journal of Medicine in February, further closing the window on speculation over the arrival of the drug from Russia, where it is an epidemic. “Our case is the first case that’s been published in a recognized medical journal.”

Last month, Drug Enforcement Agency officials in Chicago expressed skepticism about the drug’s widespread use and are waiting to confirm cases by finding out where they can get samples of the drug. But emergency rooms from Arizona to Ohio are reporting treating patients with symptoms like those Thekkemuriyil and Pillai have described.“The damage was more severe compared to a regular IV drug user,” Pillai said. “We want to keep it from spreading across our community. It eats people from the inside, it kills people from the inside literally.”